| 尚帅威,李亚仑,贝兴强,等.术前终板炎对腰椎间盘突出症术后复发的预测价值及其对术式选择的意义.骨科,2026,17(1): 39-44. |
| 术前终板炎对腰椎间盘突出症术后复发的预测价值及其对术式选择的意义 |
| The predictive value of preoperative endplate inflammation on postoperative recurrence of lumbar disc herniation and its guiding significance in selecting surgical methods |
| 投稿时间：2025-06-04 |
| DOI：10.3969/j.issn.1674-8573.2026.01.008 |
| 中文关键词: 腰椎间盘突出症 单纯摘除 镜下融合 复发率 终板炎 |
| 英文关键词: Lumbar disc herniation Simple extraction Endoscopic fusion Recurrence rate Endplate inflammation |
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| 中文摘要: |
| 目的 评估术前终板炎对腰椎间盘突出症（LDH）术后复发的预测价值及其对手术方式选择的意义。方法 回顾性分析2024年4月至2025年4月武汉市第四医院收治的217例LDH病人，其中151例接受内镜下腰椎髓核摘除术（单摘术），66例接受腰椎植骨融合内固定术（融合术）。依据术前MRI判断终板炎状态（按Modic变化标准分为Ⅰ型、Ⅱ型、Ⅲ型），记录术中出血量、手术时间、术前术后疼痛视觉模拟量表（VAS）评分、术后复发情况，采用Logistic回归分析评估术前终板炎对复发的影响。结果 单摘术病人复发率显著高于融合术病人（15.23% vs. 3.03%），在采用单摘术的病人中，术前存在终板炎病人的复发率显著高于无终板炎者（38.89% vs. 7.83%），差异有统计学意义（P＜0.05）。Logistic回归分析表明，术前存在终板炎[OR=4.107，95% CI （1.716，9.831），P=0.002]、手术方式为单摘术[OR=14.644，95% CI （3.063，70.020），P＜0.001]是术后复发的独立影响因素。ROC分析进一步提示：在全部病例中终板炎对复发的总体预测能力较低[AUC=0.557，95% CI （0.494，0.660）]，但在单摘术的亚组分析中具有较好的预测效果[AUC=0.718，95% CI （0.594，0.843）]。结论 术前终板炎会显著增加LDH病人接受单摘术后的复发风险。临床术式的选择中应将终板炎作为重要参考因素，以实现更加个体化的治疗策略。 |
| 英文摘要: |
| Objective To evaluate the predictive value of preoperative endplate inflammation on postoperative recurrence of lumbar disc herniation (LDH) and its guiding significance in selecting surgical methods. Methods A total of 217 patients with LDH admitted to Wuhan Fourth Hospital from April 2024 to April 2025 were analyzed retrospectively. Among them, 151 patients received endoscopic lumbar discectomy (discectomy) and 66 patients received lumbar bone graft fusion and internal fixation (fusion fixation). Judging the state of endplate inflammation according to preoperative MRI (divided into type Ⅰ, type Ⅱ and type Ⅲ according to Modic change standard), the intraoperative blood loss, operation time and visual analogue scale (VAS) before and after operation were recorded. Logistic regression analysis was used to assess the impact of preoperative endplateitis on recurrence. Results The recurrence rate in patients receiving discectomy was significantly higher than that in the patients receiving fusion fixation (15.23% vs. 3.03%), among patients undergoing discectomy, those with preoperative endplateitis had a significantly higher recurrence rate than in those without endplateitis (38.89% vs. 7.83%, P＜0.05). Logistic regression analysis showed that the presence of endplate inflammation before surgery [OR=4.107, 95% CI (1.716, 9.831), P=0.002] and the use of single dissection [OR=14.644, 95% CI (3.063, 70.020), P＜0.001] were independent factors of postoperative recurrence. ROC analysis further suggested that the overall predictive power of endplate inflammation for recurrence was low in all cases [AUC=0.557, 95% CI (0.494, 0.660)], but had a good predictive effect in the subgroup analysis of discectomy patients [AUC=0.718, 95% CI (0.594, 0.843)]. Conclusion Preoperative endplate inflammation significantly increases the risk of recurrence after discectomy in patients with LDH. Endplate inflammation should be considered as an important reference factor in the selection of clinical procedures to achieve a more individualized treatment strategy. |
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